Faculty Bibliography

The cost of providing healthcare in the United States continues to rise. The Affordable Care Act created systems to test value-based alternative payments models. Traditionally, procedure-based specialists such as neurointerventionalists have largely functioned in, and are thus familiar with, the traditional Fee for Service system. Administrative charge data would suggest that neurointerventional surgery is an expensive specialty. The Medicare Access and CHIP Reauthorization Act consolidated pre-existing federal performance programs in the Merit-based Incentive Payments System (MIPS), including a performance category called 'cost'. Understanding cost as a dimension that contributes to the value of care delivered is critical for succeeding in MIPS and offers a meaningful route for favorably bending the cost curve.

Radiologists are facing increasing workplace pressures that can lead to decreased job satisfaction and burnout. The increasing complexity and volumes of cases and increasing numbers of noninterpretive tasks, compounded by decreasing reimbursements and visibility in this digital age, have created a critical need to develop innovations that optimize workflow, increase radiologist engagement, and enhance patient care. During their workday, radiologists often must navigate through multiple software programs, including picture archiving and communication systems, electronic health records, and dictation software. Furthermore, additional noninterpretive duties can interrupt image review. Fragmented data and frequent task switching can create frustration and potentially affect patient care. Despite the current successful technological advancements across industries, radiology software systems often remain nonintegrated and not leveraged to their full potential. Each step of the imaging process can be enhanced with use of information technology (IT). Successful implementation of IT innovations requires a collaborative team of radiologists, IT professionals, and software programmers to develop customized solutions. This article includes a discussion of how IT tools are used to improve many steps of the imaging process, including examination protocoling, image interpretation, reporting, communication, and radiologist feedback. ^©RSNA, 2018.

OBJECTIVE:The purpose of this study was to investigate county-level geographic patterns of mammographic screening uptake throughout the United States and to determine the impact of rural versus urban settings on breast cancer screening uptake. MATERIALS AND METHODS/METHODS:This descriptive study used County Health Rankings (CHR) data to identify the percentage of Medicare enrollees 67-69 years old per county who had at least one mammogram in 2013 or 2012 (uptake). Uptake was matched with U.S. Department of Agriculture (USDA) Atlas of Rural and Small Town America categorizations along a rural-urban continuum scale from 1 to 9 based on county population size (large urban, population ≥ 20,000 people; small urban, < 20,000 people) and proximity to a metropolitan area. Univariable and multivariable analyses were performed. RESULTS:In all, 2,243,294 Medicare beneficiaries were eligible for mammograms. National mean uptake per county was 60.5% (range, 26.0-86.0%). Uptake was significantly higher in metropolitan and large urban counties in 25 states and lower in only one. County-level mammographic uptake was moderately positively correlated with percentage of residents with some college education (r = 0.40, p < 0.001) and moderately negatively correlated with age-adjusted mortality (r = -0.41, p < 0.001). Multivariable analysis showed that percentage of white and black residents and age-adjusted mortality rate were the strongest significant independent predictors of uptake. CONCLUSION/CONCLUSIONS:Uptake of mammographic screening services in a Medicare population varies widely at the county level and is generally lowest in rural counties and urban counties with fewer than 20,000 people.

PURPOSE: To characterize recent magnetic resonance imaging (MRI) technical development and innovation based on data regarding MRI-related patents awarded in 2016. METHODS: The US Patent and Trademark Office website was searched for patents awarded in 2016 and an abstract containing "magnetic resonance." Patent characteristics were summarized. An MRI physicist classified patents' themes. RESULTS: A total of 423 MRI-related patents were awarded in 2016. Among these, 29% had 1 inventor, 24% had 2 inventors, and 47% had >/=2 inventors. Mean interval between patents being filed and awarded was 1389 +/- 559 days (range: 167-4029). Most common countries of patents' first assignee were USA (40%), Germany (24%), Netherlands (10%), and Japan (10%). In all, 3% included assignees with different countries (most common collaborators USA and Germany). Patents' first assignee had an industry affiliation in 76% vs an academic affiliation in 21% (4% indeterminate); and 3% had industry-academia collaboration. Patents' most common themes were coils (n = 77), sequence design (n = 65), and noncoil scanner hardware (n = 41). These top themes were similar for USA, international, and industry-based patents; however, for academic-based patents, the most common themes were sequence design, reconstruction, and exogenous agents. Less common themes included image analysis, postprocessing, spectroscopy, relaxometry, diffusion, motion correction, radiation therapy, implants, wireless devices, and positron emission tomography-MRI. CONCLUSION: Most MRI-related patents were by non-US inventors. A large majority had industry affiliation; minimal industry-academic collaboration was observed. Patents from industry and academic inventors had distinct top focuses: hardware and software, respectively. Awareness of the most recent years' MRI patents may provide insights into forthcoming clinical translations and help guide ongoing research and entrepreneurism.

For many pathologies, early structural tissue changes occur at the cellular level, on the scale of micrometers or tens of micrometers. Magnetic resonance imaging (MRI) is a powerful non-invasive imaging tool used for medical diagnosis, but its clinical hardware is incapable of reaching the cellular length scale directly. In spite of this limitation, microscopic tissue changes in pathology can potentially be captured indirectly, from macroscopic imaging characteristics, by studying water diffusion. Here we focus on water diffusion and NMR relaxation in the human prostate, a highly heterogeneous organ at the cellular level. We present a physical picture of water diffusion and NMR relaxation in the prostate tissue, that is comprised of a densely-packed cellular compartment (composed of stroma and epithelium), and a luminal compartment with almost unrestricted water diffusion. Transverse NMR relaxation is used to identify fast and slow T

PURPOSE/OBJECTIVE:To conduct a meta-analysis of studies investigating discrepancy rates and clinical impact of imaging secondary interpretations and to identify factors influencing these rates. METHODS:EMBASE and PubMed databases were searched for original research investigations reporting discrepancy rates for secondary interpretations performed by radiologists for imaging examinations initially interpreted at other institutions. Two reviewers extracted study information and assessed study quality. Meta-analysis was performed. RESULTS:Twenty-nine studies representing a total of 12,676 imaging secondary interpretations met inclusion criteria; 19 of these studies provided data specifically for oncologic imaging examinations. Primary risks of bias included availability of initial interpretations, other clinical information, and reference standard before the secondary interpretation. The overall discrepancy rate of secondary interpretations compared with primary interpretations was 32.2%, including a 20.4% discrepancy rate for major findings. Secondary interpretations were management changing in 18.6% of cases. Among discrepant interpretations with an available reference standard, the secondary interpretation accuracy rate was 90.5%. The overall discrepancy rates by examination types were 28.3% for CT, 31.2% for MRI, 32.7% for oncologic imaging, 43.8% for body imaging, 39.9% for breast imaging, 34.0% for musculoskeletal imaging, 23.8% for neuroradiologic imaging, 35.5% for pediatric imaging, and 19.7% for trauma imaging. CONCLUSION/CONCLUSIONS:Most widely studied in the context of oncology, imaging secondary interpretations commonly result in discrepant interpretations that are management changing and more accurate than initial interpretations. Policymakers should consider these findings as they consider the value of, and payment for, secondary imaging interpretations.

PURPOSE/OBJECTIVE:To assess geographic variation in gender disparities in the US radiologist workforce. METHODS:Gender, location, and practice affiliation of all radiologists and gender of all nonradiologists were identified for all providers listed in the Medicare Physician Compare database. Variation in female representation among radiologists was summarized at state, county, and individual practice levels, and associations with a variety of county-level population characteristics were explored. RESULTS:Nationally, 23.1% (7,501 of 32,429) of all radiologists were women versus 46.6% (481,831 of 1,034,909) of Medicare-participating nonradiologists. At the state level, female representation among radiologists was overall highest in the Northeast and Mid-Atlantic regions (Washington DC, 39.3%; Massachusetts, 34.3%; Maryland, 31.5%) and lowest in the West and Midwest (Wyoming, 9.0%; Montana, 10.7%; Idaho, 11.7%). At the county level, female representation varied from 0.0% to 100.0%, with weak positive correlations with county-level population (r = +0.39), median household income (r = +0.25), college education (r = +0.23), English nonproficiency (r = +0.21), mammography screening rates (r = +0.12), Democratic voting in the 2016 presidential election (r = +0.28), and weak negative correlation with county-level rural population percentage (r = -0.32). Among practices with ≥10 members, female representation varied greatly (0.0% to 100.0%). Female representation was higher among academic (32.3%) than nonacademic (20.6%) radiologists, and in states with higher female-to-male relative earnings (r = +0.556). CONCLUSION/CONCLUSIONS:Compared with nonradiologists, women are underrepresented in the national radiologist workforce. This underrepresentation is highly variable at state, county, and practice levels and is partially explained by a variety of demographic, socioeconomic, and political factors. These insights could help inform and drive initiatives to reduce gender disparities and more actively engage women in the specialty.